Memphis Business Group on Health

MBGH Blog Posts After July 13, 2010 Now on Our New Website!

2010-08-08T23:10:00.007-05:00

MBGH's new website is now live at http://www.memphisbusinessgroup.org/home.

As of July 14, 2010, our Blog is fully integrated into our new website, so all new posts are on the website. You can continue to visit our old Blog on this blogspot for posts prior to July 13, 2010.

We look forward to having you visit our new site. Let us know what you think!

MBGH Update: Methodist Healthcare Quality Report Cards Now On-line

2010-07-13T20:51:00.000-05:00

Memphis Business Group on Health (MBGH) applauds Methodist Le Bonheur Healthcare (Methodist) for making their quality of care report card public on their websites. Specifically, MBGH is pleased with this initiative for the following reasons:

• MBGH has been working with Memphis-area hospitals since 1997 to improve transparency. As advocates for our member employers, we’ve consistently pressured hospitals to measure and publicly report their performance and to use this information to improve the quality of care they provide.

• MBGH has been asking Methodist to report quality information separately for their adult hospitals since 2002. In response to our request for Methodist to participate in our Leapfrog initiative, they have responded to The Leapfrog Group Annual Hospital Survey separately for each adult hospital. Until now, other publicly available quality reports have only been at the system level, essentially reporting average performance across the system. System-level reporting has not been useful to employers as they try to educate their employees about selecting hospitals that provide higher quality care. In this new initiative, Methodist is reporting quality information by facility which is a significant advancement.

• MBGH has asked Memphis-area hospitals to report their performance on a regular basis, which allows employer purchasers and employees to track performance over time, including whether hospitals improve performance or if there is lack of improvement. Methodist has committed to reporting this information regardless of whether it shows they are providing quality care or if they need to improve, thereby providing the good news and the not-so-good news.

This initiative is an excellent first step in increasing transparency with area employer purchasers and employees/potential patients. MBGH asks that all Memphis-area hospitals look to this as a local transparency standard they should try to meet and exceed.

As this initiative takes root, MBGH asks all Memphis-area hospitals, including Methodist, to add additional critical information to their online information. Information on outcomes, such as survival rates/mortality rates; structure measures such as staffing in ICUs and computerized physician order entry; and hospital acquired conditions, such as falls, pressure ulcers, and infections is already available and would not require significant work to add to the reports.

Gary Shorb, President and CEO of Methodist Le Bonheur Healthcare, emphasizes their commitment to working with MBGH and purchaser employers to provide additional information that is useful to employers and their employees. MBGH is meeting with Gary and senior Methodist staff to work out the specifics and timeline. We will keep you up-to-date as details are finalized.

We welcome the opportunity to work with other Memphis-area hospitals, as well, as they develop their transparency strategies.

In the meantime, we encourage you to access and use the Methodist Healthcare information by clicking below:

Methodist Healthcare Adult Quality

Le Bohneur Children’s Hospital Quality

DOL FAQ on Mental Health Parity Offers Guidance for Grandfathered Plans

2010-07-07T08:30:00.000-05:00

Click here to read Buck Consultants' summary of how recently released DOL FAQ (click here to read) on mental health parity impacts grandfathered status under health reform.

J.D. Power 2010 Employer Health Insurance Plan Study Shows Low Satisfaction Rates

2010-06-29T21:45:00.004-05:00

According to J.D. Power, there are overall low employer satisfaction rates (61%) with health plans. Service outranks cost & benefits as satisfaction driver. Employee plan servicing ranked #1, with account servicing and product offering/design ranking 2nd & 3rd. Go to http://bit.ly/blTq3t for the press release re: major study findings.

The LA Times reports that health plans are ramping up customer service to compete post-health reform. Guess the JD Power employer survey was right! http://bit.ly/9N82ix

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MBGH Participating in TN's All Claims Database Development

2010-06-29T18:20:00.003-05:00

MBGH is a member of the Tennessee Health Information Committee which oversees the development of TN's all claims database in terms of information that is collected and information that is publicly reported.

Click here to read a report which summarizes why states are creating these all claims databases. Examples of how information from these databases can be used include:

Employers can begin to understand the variation in cost and utilization by geographic area within a state;
The value equation (cost & quality) of new health care services can be assessed;
The design and implementation of health reforms can be informed by data and data can be tracked to determine impact;
Compare prevalence of disease across populations;
Determine payer competitiveness;
Report on the cost and quality of individual providers.

TN's all claims database is currently in the data collection process and the first public reports are expected in 2011. MBGH will keep your members informed as information becomes available.

PWC Report Forecasts 2011 Employer Health Benefit Trends

2010-06-29T18:05:00.001-05:00

PricewaterhouseCoopers’ Health Research Institute surveyed 700 U.S.-based companies, small through jumbo sized, to gauge their perspectives on health care costs and benefits program priorities for 2011. Interviews were conducted in the first quarter of 2010. Click here for a copy of the report.

Major findings include:

Medical costs are projected to increase 9% in 2011.
More employers will move away from co-payments & toward co-insurance at the point of care.
Hospitals, getting less from Medicare, will cost-shift to employers/commercial to make it up.
Providers will merge and consolidate, creating greater leverage in negotiations with health plans.
Employers plan to add more worksite wellness & health promotion programs.

MBGH Worksite Wellness Project with Health Department Gets National Recognition

2010-06-29T17:46:00.000-05:00

Click here to see the article on this project in the Memphis Business Journal.

The Memphis Business Group on Health (MBGH) received one of seven national Community Health Partnerships (CHP) Population Health Seed Grants. The $12,911 grant was awarded by the National Business Coalition on Health through the Community Coalitions Health Institute (CCHI).

The grant will fund a joint program between the Memphis Business Group on Health (MBGH) and the Memphis Shelby County Health Department (MSCHD) to study the effectiveness of the Move More, Eat Better…It All Works Together Fitness Challenge in the workplace.

The MSCHD has been offering the Move More, Eat Better…It All Works Together Fitness Challenge through churches and community centers. The program is funded by the State of Tennessee Department of Health. Despite the fact that the program is free to employers, The MSCHD has had a difficult time getting employers to offer it at worksites.

Memphis Business Group on Health is a coalition of member employers sharing solutions and providing tools to manage the cost and quality of health benefits. As part of the grant, MBGH has secured participation of four member employers, including the Memphis Shelby County Airport Authority and Merck. The employers will enroll approximately 120 employees in the challenge, which lasts six weeks.

Health department staff will record the employee’s blood pressure, weight and Body Mass Index (BMI) at the beginning of the challenge and compare it to the employee’s final numbers six weeks later. During that period, MSCHD staff will provide weekly educational programs to employees on topics such as nutrition and exercise.
Incentives for participants include pedometers, waist circumference tape measure, hand sanitizer, jar grips, pens, notepads. The grand prize, a George Foreman grill, is awarded to the participant making the most significant progress toward better health.

The Memphis Business Group on Health will track the initiative from an employer’s perspective, measuring employee engagement, realized benefits, and employer satisfaction. As part of the grant, MBGH will recommend how the program may be modified to make it more successful in the workplace in the future. Results will be published in a white paper and made available to employers and other communities.

“In Memphis, employers have historically perceived the Health Department as an organization that helps the uninsured and the under-insured and not employers,” said Cristie Upshaw Travis, Chief Executive Officer of The Memphis Business Group on Health. “The department is an underutilized resource that we can tap to help deliver better value to our member organizations. For example, we worked with the MSCHD to help our employers implement H1N1 Flu shot programs.”

Health Reform Resources Added in June

2010-06-29T17:36:00.001-05:00

Quite a bit of activity in June related to health reform. You can click the following links to access the latest information. Don't forget to click here to go to MBGH's Health Reform Resource Center for the 30+ postings on health reform information important for employers.

Click here to read Health Reform GPS's summary of Health Insurance Reforms & Grandfathered Plans (6/26/10)
Click here to read the HHS press release on regulations for grandfathered plans (6/14/10).
Click here to read the HHS Q&A on the regulations for grandfathered plans (6/14/10)
Click here to read National Business Coalition on Health's Action Alert on the release of the official application & application instructions for the early retiree reninsurance program (6/29/10)
Click here to read Milliman's assessment of the impact of health reform on Large Employers (6/11/10)
Click here to read FAQ's about health reform from Buck Consultants (6/21/10)

Memphis Medical News Reports on MBGH Leapfrog Rewards

2010-06-05T08:27:00.000-05:00

Click here for the Memphis Medical News article on MBGH's April Annual Awards Luncheon where we recognized hospitals for their national performance and "best odds of survival".

Why Do Employees Not Take Their Meds?

2010-06-03T20:56:00.000-05:00

Interestingly, cost is the not the only reason. Seems convenience is too. This article suggests physician offices should dispense prescription drugs. Evidence also shows that worksite clinics that dispense drugs save employees and employers dollars and increase adherence.

Click here to read the blog post on this issue.

Memphis Hospitals Continue to be Challenged by Infections

2010-06-03T20:47:00.000-05:00

Click here to read the latest article on hospital infection rates in Memphis.

MBGH has been working through The Leapfrog Group and other ways to push hospitals to reduce hospital infections, which cost both dollars and lives.

Click here to see Leapfrog Hospital Survey results for Memphis hospitals which include infectionr rates in ICUs. Share this important information with your employees so they can select hospitals that provide a higher level of quality, safe care.

Work-Site Clinics Beginning to Show Up in Memphis

2010-06-03T20:41:00.000-05:00

MBGH suggests that as work-site clinics expand their focus from helping employees with acute episodes (such as sinus infections, colds, etc) to providing on-going care for those with chronic conditions, the value of work-site clinics will increase for employers.

Click here to read the article describing how work-site clinics, though slow to catch on in Memphis, are beginning to pop up over town.

Implementing Mental Health Parity

2010-05-28T08:49:00.001-05:00

Click here to check out Milliman's new resource on implementing mental health parity.

Issues covered include:

Deductibles and out of pocket limits
Coordination with EAP services
Separate coverages or benefit packages
How to deal with providers, specialists, primary care
Quantitative vs. non-quantitative benefits (very controversial)
Compliance

More Updates on MBGH's Health Reform Resource Center

2010-05-26T16:32:00.000-05:00

Click here to go to MBGH's Health Reform Resource Center to see the latest information posted on:

Employer uptake on early retiree reinsurance program
How employers are handling expanding coverage to <27 year olds
Guidance on Extension of Children's Health Coverage to Age 26
New resource on health reform provisions that apply to grandfathered plans
How employers are reacting to Health Reform

And more!! Check back often as the resource center is updated as important information becomes available.

Mercer Reports on How Large Employers Are Reacting to Health Reform

2010-05-20T19:05:00.001-05:00

Click here to read results from Mercer's survey of 800 large employers which shows that:

■Early estimates of cost impact range from moderate to severe, with 30% of employers surveyed still in the dark
■Even so, the excise tax on high-cost plans – which doesn’t kick in until 2018 – tops employers’ list of concerns
■Retailers concerned about cost of expanding coverage to more part-timers
■Employers considering several options for offsetting cost of covering adult children

Most large employers are waiting unitl their new plan years to implement coverage for <27 year olds. Click here to read an NPR article on this aspect of the survey results.

Pushing for Market-Level Health Plan Performance Reporting

2010-05-13T21:36:00.000-05:00

I attended my first NCQA Purchaser Advisory Council today and it was a great meeting. NCQA is addressing the latest in health reform issues, including exchanges, accountable care organizations, relative resource use and furthering its work in wellness/health promotion and medical home. I am excited about the tools and information NCQA is working on, most of which measure and report performance at a plan or vendor level.

But I am struck by the fact that although reporting at the plan or vendor level often works for individual employers, those of us involved in community-level change need this valuable information cut in a different way. For example, health plans in TN report their HEDIS measures at a statewide level. Works for employers that have employees across the state, but does not work for those of us wondering how plans are peforming in Memphis specifically. Another example is the wealth of information that will become available through NCQA's relative resource use reports, which, once again, look at the plan's performance across the entire state.

It is great to know how health plans perform, in general across TN, but it would be even more powerful and actionable to know how they perform in each market in TN. That would tell us more about our own providers and their performance and help identify what we need to improve locally and may even give us hints about how to improve it. Because of contracting methods here in Memphis, where plans contract either with Baptist or Methodist, but generally not with both, we could even begin to understand if there are any real differences in the quality and resource use between our two major hospital systems and their affiliated physicians.

Understanding whether these differences exist between Baptist & Methodist is critical to local employers, and their employees, in knowing where to go for safe, high quality, efficient care.

NCQA is pushing itself to be relevant, vital, and address the current issues that are even more important due to health reform. The next challenge will be how to make this information relevant and usable by communities as well as individual employers. I hope I can bring this perspective to NCQA as I continue to serve on their Purchaser Advisory Council.

More Resources on Grandfathered Plans & Early Retiree Reinsurance Now on MBGH Health Reform Resource Center

2010-05-09T17:20:00.000-05:00

Great resources from national experts now uploaded on MBGH's Health Reform Resource Center on our temporary website. Click here to access the following:

Proskauer's presentation on Grandfathered Plans & Exception for Collectively Bargained Agreements (4/29/10)
Groom Law Group chart identifying sections effective for Grandfathered Plans (4/2/10)
Groom Law Group Memo on Interim Final Regulationson Retiree Reinsurance Program (5/6/10)
Buck Consultant's summary of HHS Interim Final Regulations on Retiree Reinsurance Program (5/6/10)
Paul Hasting's "Early Retiree" Retiree Health Insurance Initial Observations & First Guidance (5/4/10)

Check Out New Postings on MBGH's Health Reform Resource Center

2010-05-06T17:07:00.001-05:00

Click here for the latest information posted on MBGH's Health Reform Resource Center:

IRS guidance on tax-free employer-provided heatlh insurance for children under 27
HHS Releases Regulations on Early Retiree Reinsurance Program from Buck Consultants
How Will Reform Affect Large Employers? from Jenny Ivy at Benefits Selling
Employee Benefit News is Establishing Health Reform Study Groups

While on the temporary website, check out the Tobacco Cessation Benefit Tools & Solutions Center & the Diabetes Benefit Tools & Solutions Center. Next new Center will focus on Pharmacy Benefits!!!

MBGH Recognizes 5 Memphis-area Hospitals for "Best Odds of Survival"

2010-04-30T13:07:00.000-05:00

Click here to read about MBGH's Leapfrog awards to 5 Memphis-area hospitals that have "best odds of survival" in the Memphis Daily News.

Click here to read the press release which talks about other Memphis-area findings from the Leapfrog Hospital Survey, including how Memphis hospitals compare to hospitals nationally on COST of care.

Memphis Employers Using Incentives & Data to Control Health Benefit Costs

2010-04-26T11:59:00.001-05:00

Check out MBGH's comments on how Memphis-area employers are controlling health benefit costs through employee incentives and providing data to make informed choices. Click here to read the Memphis Business Journal article.

Work-Site Clinics Gaining Favor Over Retail Clinics

2010-04-25T16:48:00.000-05:00

Read this good article that traces the development of retail walk-in clinics at pharmacies such as Walgreens, CVS and Kroger and compares, as well as their aggressive expansion into the world of "work-site " clinics. Both models are a reflection of pharmacies efforts to rebrand themselves as health & wellness companies. Both models are also focused on cutting employee and employer costs. Today, work-site clinics appear to have the most growth potential.

Get the latest on Retiree Reinsurance Program

2010-04-20T19:22:00.000-05:00

Click here to check out Sebelius' address on retiree reinsurance program. Important information for employers!!

Curious About How Part-Time Employees Are Addressed in Health Rerform?

2010-04-18T10:37:00.000-05:00

Click here to get the latest from MBGH on Health Reform. Latest addition to our resource center is a summary from Bass Berry & Sims about how part-time employees are addressed in health reform.

MBGH Presents on Health Reform to Tennessee Personnel Management Assoc.

2010-04-17T17:18:00.001-05:00

Click here to check out MBGH's Health Reform presentation to the Tennessee Personnel Management Association on April 15, 2010 for a reminder on why there was such a push for health reform, how we got health reform, how what we got addressed the issues that pushed reform to happen, and some key provisions impacting employers.

Latest on How Employers Are Preparing (Reacting) to Health Reform

2010-04-13T20:01:00.000-05:00

As the dust begins to settle on what actually was passed in health reform, employers are reacting and beginning to prepare to deal with what appears to lie ahead. Greatest concern is being voiced over extending dependent coverage to age 26; extending coverage to part-time employees that work 30 hours/week; caps on FSAs; and the elimination of tax deductability for Mediare Part D subsidies for retiree health plans and on lifetime and annual limits, all of which will increase employer costs.

But many say the version that passed is less onerous than previous versions with delays in implementation of controversial issues including the excise tax on "cadillac" plans and the inclusion of some positives in terms of payment & quality demonstrations. Plus, employers "dodged" the strong employer mandate that had been in the House bill.

In addition to all of these changes, and more, employers will take on additional administrative tasks, which, as we all know, end up costing employers significantly in compliance issues.

Read these two article to get a feel for how employers are preparing and reacting as the dust begins to settle.
Click here for "Employers Scamble to Catch Up with Health Reform's Immediate Impact" and here to read "Benefit Managers Eye Impact of Health Reforms".

The VA Saves $3 Billion over 10 Years with HIT Systems

2010-04-09T15:17:00.000-05:00

The VA system reports that implementing health information technology has saved them $3billion from 1997-2007 through reductions in duplicated tests and medical errors, as well as operating efficiencies. Technology implemented included computerized patient records, bar coded medications, radiology, laboratory and medication ordering. Imagine the savings we could have in Memphis if all of our systems implemented these same technologies!!! Quality of care also improved during this period. You can track Memphis hosptial progress in implementing computerized provider order entry for medications by reviewing The Leapfrog Hospital Survey results here (see "Prevent Medication Errors"). We have a long way to go in this area. Methodist Healthcare indicates that Methodist North and Le Bonheur are now operational and the remainder of the system should be operational by 2011.

Click here to read an article about the VA experience.

MBGH Celebrates the Spirit of Memphis

2010-04-08T19:14:00.000-05:00

Get into the Spirit of Memphis!!! Our city, heritage, music, food, culture, people...our spirit...is what makes us great. Celebrate it!!

More on How Health Reform Impacts Employers: Latest from SHRM

2010-04-06T07:59:00.000-05:00

Click here to get the latest on how health reform impacts employers. Includes SHRM April 5, 2010 HR Week Health Reform Update. Please note, some of the links on SHRM's update are for SHRM members only.

Resource for Employers to "Navigate Health Reform"

2010-04-05T22:07:00.001-05:00

The Groom Law Group slides presented at the American Benefits Council on March 31, 2010 are a good resource to navigate the recently passed health reform legislation and identify what self-insured as well as insured plans must do to comply. Click here to access the slides as well as other resources on health reform.

Employers: Focus on These Aspects of Health Reform NOW!!!

2010-04-02T20:20:00.000-05:00

Click here to hear Steve Wojcik, vice president of public policy for the National Business Group on Health, offer his take on what employers should have top of mind between now and when the biggie components of the Patient Protection and Affordable Care Act take effect in 2014 and 2018.

MBGH Says: Real Cost Reform is Still to Come

2010-04-01T10:15:00.001-05:00

Memphis Business Group on Health's work is highlighted in the April 1, 2010 Memphis Business Quarterly blog. The posting focuses on the need for real cost reform -- saving dollars and improving quality by preventing things that should not happen and improving health and saving dollars by doing things we should be doing to take better care of ourselves.

There is also a link to the Leapfrog Hospital Survey results for Memphis hospitals.

Check the Memphis Business Quarterly blog out regularly for other Memphis business-related postings.

Not Paying for Readmissions Spurs Improvements in Patient Care

2010-04-01T08:48:00.000-05:00

It is estimated that 75% of the Medicare admissions readmitted to the hospital within 30 days of discharge were preventable. In total, the cost of readmissions to Medicare is approximately $17.4 billion annually.

Medicare's decision NOT to pay for preventable/avoidable readmissions to hospitals has gotten attention. Significant work is now being done by hospitals to put better discharge and/or transfer processes into place to better coordinate care, ensure patients have support systems at home and get needed followup services. A good example of how aligning payments with desired outcomes serves as the main "carrot or stick" to get action. And, a good example of how poor quality care drives high cost.

Click here to read the article. The clear connection between aligning payment with expected outcomes is in the last paragrah.

Patient Safety Incidents Cost $8.9 Billion Annually

2010-03-31T09:06:00.000-05:00

Latest Health Grade's Patient Safety in American Hospitals study finds that there was little progress in reducing patient safety incidents in hospitals for Medicare patients in 2009. They estimate that these patient safety incidents added $8.9billion to the cost of health care in 2009 and that almost 100,000 Medicare patients died as a result of these incidents.Top performing hospitals had 43% fewer incidents than poorly performing hospitals.One more example of how costly poor quality is!!!

Click here to read an article about the report.

Find Out How Health Reform Impacts Self-Insured Employers

2010-03-31T08:45:00.000-05:00

The dust is beginning to settle a little. Find out what we know now about how health reform impacts self-insured employers. Click here to go to MBGH's Health Reform Updates website & download the Employer Implementation Summary provided by National Business Coalition on Health.

Corporations Push For Repeal of Redeuced Tax Deductions in Health Reform Law

2010-03-29T21:35:00.000-05:00

Key corporations claim that health reform bill's repeal of employer tax deductions for retiree drug subsidies will hurt their bottom lines.

Click here to read the NY Times article.

Follow MBGH on Twitter!

2010-03-28T12:07:00.001-05:00

MBGH is now on Twitter! Help us grow our followers by clicking the twitter logo.

It's Coming Down to the Wire, Help Memphis Get Google Fiber!!

2010-03-25T07:01:00.001-05:00

Show your support for Memphis to get Google Fiber. Go to http://www.google.com/appserve/fiberrfi/public/options to complete a nomination for Memphis; join Google Fiber for Memphis, TN's Facebook page

Attend University of Memphis Health Law & Public Polcy Symposium, March 26

2010-03-24T16:01:00.001-05:00

Click here for brochure and registration

Health Law and Public Policy:
An Introduction to America's Trillion Dollar Business

History will cement this week as the one which saw the passing of the most significant health law legislation in half a century. Join us for an up-to-the-minute discussion with national authorities never before brought together in Memphis, on The Health Care Ecosystem in Transition; Biomedical Research; Health Care and Economic Development; Health Information Management, Electronic Records and E-Discovery; Perspectives on Health Care Reform; and a Leadership Panel Discussion on Health Care and Public Policy. The day's program will close with an outstanding Leadership Panel comprised of the CEOs from St. Jude Children's Research Hospital, Baptist Memorial Health Care Corporation, Methodist LeBonheur Healthcare, and St. Francis Healthcare. You don't want to miss this.

Friday, March 26, 2010

8:30 a.m. – 6:00 p.m.

To be held at the beautiful new downtown location of the

Cecil C. Humphreys School of Law

One North Front Street

Memphis, Tennessee

Memphis Businesses Get Head Start on Health Reform through MBGH

2010-03-23T18:18:00.000-05:00

Click here to read the ABC24 Eyewitness News report (aired on March 23 at 5:00) on the role MBGH plays in health reform.

In the interview, Cristie Upshaw Travis said that even though access to health care dominates the talk about health care reform, Travis said there’s more to the issue. “If we don’t pay attention to the cost and quality of services that everybody receives, we will never see an end to increased costs related to health care.”

MBGH "Ahead of the Health Reform Curve"

2010-03-23T07:24:00.001-05:00

Click here to read the Daily News article on MBGH being a leader in preparing Memphis employers, hospitals, health plans and other providers for health reform.

Note: Cristie Upshaw Travis is a member of the Purchaser Advisory Council for NCQA, not a member of the Board.

What Do Physicians Think Employers Should Do?

2010-03-18T19:17:00.001-05:00

What do physicians think employer's should do?

82% think employers should offer employees incentives to manage their chronic diseases and/or stay healthy
70% think employers should reduce or waive copays to increase adherence on medications

These strategies are consistent with the current emphasis on "value-based benefit design" which uses benefit design to motivate employees to use high value services which will keep them as healthy as possible for as long as possible.

What do physicians want from employers?

62% want to know about worksite and employer-based programs so they can counsel patients on participation
47% think benefit design should "be an extension of the physician's treatment program" leaving them in control of treatment decisions.

The study, conducted by the Midwest Business Group on Health, also concludes that communication between employers, employees and physicians is critical to improving/maintaining health.

Check out an article on the study by clicking here.

Unnecessary Angiograms Are Very Costly to Your Health Plan

2010-03-11T11:15:00.002-06:00

Recent study released in the New England Journal of Medicine shows that 62% of 400,000 patients that had no known heart disease and were not receiving emergency heart care had no significant heart blockage found in their angiogram results. The study suggests that physicians should do a better job of identifying those patients that need an angiogram, especially for the 20-30% of the patients that have no symptoms.

Medicare pays about $1,400 for an outpatient angiogram and $3,000 for an inpatient angiogram. Private payors typically pay more. So performing angiograms on patients that do not have significant heart blockage is very costly to you as an employer. For these 62% of the patients, payments could be an estimated $446 million (note: estimated by MBGH. Although the test may have not shown any significant blockage, it may still have been appropriate for some of these patients)

So, what can you do about this?

Encourage your employees to discuss less invasive alternatives, and the risks associted with these as well as angiograms, with their physician.
Check with your health plan to see what type of decision support tools they are offering your employees and how they let your employees know these tools are available. Also ask them how many employees actually use these tools.
Consider plan design triggers that require accessing decision support services for non-emergencies through the plan prior to scheduling invasive tests.

Click here to read the Yahoo article which includes a link to the New England Journal of Medicine.

Latest Health Reform & Legislative Update from MBGH & NBCH

2010-03-10T20:58:00.001-06:00

Click here for the latest update on health reform and the Mental Health Parity Act provided by the National Business Coalition on Health.

Updates on:

Part-Time Employee
Health Savings Accounts (HSAs)
Retiree Drug Subsidy Tax
Insurance Reform Effective Dates and Transition Period
Interim Final Regs Issued for the Mental Health Parity and Addiction Equity Act of 2008

Cost Effective, Quality, Safe Care Must Be Part of the Med's Plan

2010-03-08T08:42:00.001-06:00

Merely waiving co-pays and deductibles is not enough to accomplish what The Commercial Appeal's editorial says the Med must do: "The Med has to convince potential paying patients that it's a quality alternative for medical care."

Waiving co-pays and deductibles reduces financial barriers for patients, but in no way ensures that the care they receive is efficient, high quality, and safe. People should have information on the cost and quality of care at the Med to decide if the waived financial requirements are "worth it". But much of the cost and quality information that is available for all the other hospitals in Memphis is not available for the Med because the Med does not publicly report this information through The Leapfrog Group's Annual Hospital Survey (click here to get results for other Memphis hospitals).

Information that is publicly available on the Med's quality of care shows that significant opportunities for improvement exist. For example, recently released statistics on central line infections in ICUs shows that in 2008, the Med's rate of infection was approximately 238% above the average (click here to read Consumer Reports Health article and click here to get State of Tennessee report) . The Med indicates that they have been addressing this issue, but it would be good for us to know what progress they have made in bringing the infection rate down. If the Med reported to The Leapfrog Group survey, we would know how effective their improvement efforts have been and could track their progress.

In addition, the Med's scores on patient experience of care measures from Medicare's survey for the 12-months ending March 2009 show that only 56% of the patients would "definitely recommend" the hospital to others (compared to a national and statewide 68% average).

Finding a financial solution to the Med's situation is essential, but the Med owes us cost-effective, high quality, and safe care. They owe us this under all circumstances, but especially if they are going to offer us financial incentives to use their services. It is not right to ask people to make the decision to come to the Med based only on the fact that they will "save money". The Med should participate, as all other Memphis hospitals do, in the Leapfrog survey so people can decide if the quality of care they are likely to receive is worth saving money because there are no co-pays or deductibles.

Click here to read the latest Commerical Appeal editorial.

Benefit Plan Costs Could Increase if Med waives Co-Pays, Deductibles

2010-03-05T07:40:00.001-06:00

The Med's strategy could end up costing Shelby County's benefit plan a lot more money!! Co-pays and deductibles play an important role in encouraging employees to use the appropriate level of care..e.g., a primary care physician vs. an emergency room. If insured employees go to the Med vs. their physician office because there is no co-pay, costs will increase to the plan. Something that needs to be thought about..

Click here to read the CA article.

7 Ways to Cut Benefit Costs Without Cutting Coverage

2010-02-27T11:27:00.001-06:00

Although this article is from 2007, these strategies are still something to at least think about!! MBGH still hears a lot about:

Covering preventive services at 100%
Mandating mail order
Moving from the carrot to the stick (or as a speaker referred to it lately, as a "frozen carrot")
Auditing enrolled dependents

Click here to read the Workforce.com article. You will need to register to see the article,but it is free!!

Handy Tool to Assess Your Dental Benefit Offerings

2010-02-27T11:15:00.002-06:00

Check out this article which gives you an easy way to assess the quality of your dental benefits. Key aspects include:

Offering the right preventive services
Giving employees access to dental risk assessments
Maximizing flexible spending accounts
Communicating effectively with your employees

Click here for the article from Workforce.com. You will need to register, but it is free!!

More Cost-Effective Dental Benefits Now Available

2010-02-27T11:08:00.001-06:00

Tailoring dental benefits to the needs of your employees, including medical conditions they may have such as diabetes, can help you save dollars down the road. Click here to read the Workforce.com article. You may need to register, but it is free!!

MBGH Launches: Tobacco Cessation Benefits Tools & Solutions

2010-02-26T20:00:00.000-06:00

MBGH launches its first Tools & Solutions center focusing on tobacco cessation benefits. Building off of our successful February 25, 2010 meeting, Smoking Cessation: The Purchaser Perspective, MBGH has created a web page dedicated to key information employers need to manage the cost & quality of their tobacco cessation benefits.Click here to access the web page.

Included on this web page are:

Presentations from the February 25, 2010 meeting
Purchaser's Guide: Summary Plan Description Language for tobacco use treatment
Partnership for Prevention Business Outreach Package on Tobacco Cessation
Employer Case Studies
Sample Policies
Publications

This site will evolve over time with new tools & solutions added as they are identified. Once our new website is launched, this information, as well as other information on other key benefit issues, will be available for our members/affiliates and supporters at the Patron level and above.

MBGH is committed to providing our members with current tools & solutions to manage the cost & quality of their health benefits in an ever-changing environment.

Pharmacist-based Program Proves Effective for Diabetics in Polk County, FL

2010-02-25T15:54:00.001-06:00

An employer-based clinical pharmacist counseling program for type 2 diabetes patients in Polk County, FL led to a 9% improvement in A1C levels, a 30% decrease in hospitalizations, and a 24% decrease in ER visits. These results of this 2005 study are reported in the February 15, 2010, American Journal of Health-System Pharmacy.

The pharmacist provided six 30-minute counseling sessions and copays were waived for disease-related medications, supplies, and non-prescription products. Participants were asked to sign an agreement to comply with program rules and processes. A total of 564 enrolled in the program and 477 were still active in the program at the end of 12 months.

Click here to read the article.

Price Increases Drive Spikes in Massachusetts Health Care Costs & Premiums

2010-02-24T15:03:00.000-06:00

Massachusetts' recent spikes in health care cost (and increases in premiums) have been caused primarly (75%) by price increases from hospitals and physicians and only 25% have been caused by utilization increases.

The preliminary report from the Massachusetts' Attorney General, also finds that provider payments do not correlate to quality of care or to the actual cost of providing the service. Instead, payments are closely related to provider size and market dominance.

The report also found that in some instances some providers were paid twice as much for the same service as other providers.

Click here to read the article.

Cut Cost by Reducing Hospital-Acquired Conditions: Sepsis & Pneumonia

2010-02-23T22:16:00.000-06:00

Study results reported by Extending the Cure in The Archives of Internal Medicine indicate that patients that develop sepsis (a systemic response to infection) after surgey end up staying an extra 11 days in the hospital at an average cost of an additional $33,000. In addition, 20% of these patients die of the infection.

The study also found that patients that develop pneumonia after surgery, often due to a dirty ventialtor tube, stay in the hospital an extra 14 days and cost an additional $46,000. 11% of these patients die of the pneumonia.

According to Ramanan Laxminarayan, Ph.D., principal investigator, "In many cases, these conditions could have been avoided with better infection control in hospitals.”

This study presents one more piece of evidence that improving the quality & safety in hospitals not only saves lives, but saves dollars as well.

Click here to read the article.

Improve Worksite Wellness Programs with Social Networking

2010-02-23T21:03:00.000-06:00

In this AHIP Bridgecast, hear Rajiv Kumar of Shape Up the Nation address how social networking can improve the effectiveness of your worksite wellness programs. He explains that social networks essentially harness connections that people already have in order to help change behavior and improve health. Evidence shows that health behaviors spread from person to person within their social networks of family, colleagues, neighbors. Understanding how to use these natural networks as part of your wellness strategy is the subject of this podcast.

Click here to hear the podcast.

MBGH 2010 Health & Productivity Forum Panel Featured in Business Insurance

2010-02-23T20:41:00.000-06:00

MBGH highlighed our work with the Healthy Memphis Common Table at the recent Integrated Benefits Institute/National Busienss Coalition on Health 2010 Health & Productivity Forum in San Antonio, TX. Other panelists included Savannah Business Group on Health and Mid-America Coalition on Health Care (Kansas City).

Click here to read the Business Insurance article.

President Obama Releases 11-page Outline of Health Reform Proposal

2010-02-22T10:51:00.000-06:00

President Obama has released his health reform proposal outline.

Click here to read a Modern Healthcare article.

Clickk here to see the outline.

Power Pauses Can Increase Your Employee's Productivity & Effectiveness

2010-02-20T11:04:00.002-06:00

Ever heard of a "Power Pause"? These 10-15 minute "time outs" during your employee's work day can increase their productivity & effectiveness. Power Pauses give employees time to reflect over what they have accomplished so far that day and to plan the rest of the day. At the end of the day, take a pause to plan for the next day.

Even better, combine a Power Pause with a physical activity, such as walking, biking, or jogging. This alone time, combined with physical activity, can really rejuvenate the spirit as well as body!!

Try it yourself and considser sharing this concept with your employees in your next employee newsletter!!

Click here to read the CA article on Power Pauses.

Be Alert on Monday, February 22: Obama to Release Compromise Health Bill

2010-02-19T14:30:00.000-06:00

President Obama to release compromise health bill in advance on health summit to be held next week. Plans are to attach the compromise bill to a budget bill, which should avert a Republican fillibuster. But Congressional Democrats have not yet seen the compromise bill and have not signed on yet. Republicans are cautioning Democrats not to "finalize" their bill until after the summit.

The Plan will be posted on the internet Monday morning, so check it out early.

Click here to read the article.

HHS & Insurance Company Exchange Heats Up

2010-02-19T13:45:00.000-06:00

HHS Secretary Kathleen Sebelius announced the release of a new report "Insurance Companies Prosper: Families Suffer" and blasts insurance companies for significantly raising premiums, using MI (56%), ME (23%), CA (39%), and CT (24%) as examples. But insurance companies are striking back claiming that the plan "villification" should stop and that the premium increases should be put into perspective, especially as it relates to healthcare cost increases.

Click here to read an article from HealthLeaders Media.

Click here for a copy of the report.

MBGH Leading Employer Contributions to Improving Health in Memphis

2010-02-19T08:26:00.000-06:00

MBGH supports the Commercial Appeal's call for employers, churches, civic organizations, and government to get involved in improving health in Memphis..each group should work within their sphere of influence & responsibility to contribute to the overall improvement in our community's health...MBGH is taking leadership in working with employers by sharing solutions and providing employers tools includng health benefit design, worksite health-related programs, and building an overall culture of health to improve the health and productivity of their employees and to use their health benefit dollars efficiently.

Click here to read the editorial.

Health Plan Performance Improving Slightly for Diabetes, But More Work Needed

2010-02-18T14:57:00.000-06:00

The National Business Coalition on Health's just released 2009 Health Plan Diabetes Performance report shows that there is only slight improvement in outreach and outcomes for diabetics in the surveyed plans. Approximately 81% of the diabetics had at least one A1C test, but approximately 43% of them had uncontrolled blood sugar levels.

These challenging outcomes exist even while large numbers of plans and their customers are using:

Disease management
Personal health assessments
Gaps in care reminders for physicians
NCQA's physician recognition program which identifies physicians with quality outcomes for their diabetic patients.

Dennis White, Senior VP for Value-Based Purchasing at NBCH states, "Now the challenge is getting consumers engaged, using the tools, but also better coordination with employers for things like plan design and cultural reinforcement, and doctors to track and act on gaps in care.”

So, what are you doing in your plan design to help your outcomes improve?

This annual report is based upon results for the 70 health planscovering approximately 96 million Americans that particated in NBCH's 2009 eValue8 program. In Tennessee, BlueCross BlueShield of Tennessee and CIGNA Healthcare of TN provided information through Memphis Business Group on Health.

Click here to read the Business Insurance article on the report.

Click here to access a copy of the report.

Reduce Total Cost & Improve Diabetes Medication Adherence through Value-Based Plan Design

2010-02-17T14:07:00.002-06:00

A CVS-Caremark study released in the American Journal of Pharmacy Benefits shows that eliminating or reducing co-pays for diabetes medication can improve medication adherence. The study compared 20,000 participants in a value-based benefit design to over 190,000 participants in a standard 3-tier co-pay benefit design.

A separate study released by the New England Healthcare Institute shows that not taking medications properly leads to higher costs, more hospitalizations, and poorer health, adding about $290 billion annually to the nation's health care spending.

Click here to read about the study findings.

Check Out How Shelby County Ranks

2010-02-17T13:31:00.001-06:00

Check out how Shelby County ranks in the County Health Rankings just released by the Robert Wood Johnson Foundation & the University of Wisconsin. Click here to get to a snapshot of Shelby County's results.

Our biggest opportunities are in improving health behaviors (especially obesity, binge drinking, chlamydia rate, and teen pregnancy rate) and our physical environment (including air pollution, access to healthy foods, and liquor store density).

Shelby County's socieo-economic status also significantly affects our rankings. Our low high school graduation rates, high rates of children in poverty, high percentage of single-parent households, and high violent crime rate all impact our score.

We scored ok on clinical care with moderate improvement opportunities in most measures.

The rankings consider:
Mortality
Morbidity
Health behaviors
Clinical care
Social & economic factors
Physical environment.

Bredesen's Budget Includes No Extra Funds for The Med

2010-02-02T08:23:00.000-06:00

Looks like a "business as usual" proposal from The Med is a non-starter. Where is the creative plan that paints a different vision?

Click here to read more details.

MBGH Convenes Members to Improve Depression Care for Employees

2010-01-29T13:29:00.002-06:00

Thank you to Donna Marshall, Executive Director of the Colorado Business Group on Health, for meeting with 9 Memphis employers to encourage them to improve the depression care their employees receive. Donna's visit is part of a National Institutes of Mental Health-funded research project to understand how employers make benefit decisions regarding depression care. MBGH's eValue8 project shows that there is significant improvement needed in behavioral health care in Tennessee. Attendees learned that they should encourage their plans to:

Provide feedback to physicians about the quality of depression care they provide their patients
Lower co-pays, co-insurance for depression medication
Lower co-pays, co-insurance for behavioral health physician visits.

These 3 actions lead to improved adherence to therapy which results in better outcomes, health, and productivity. In other words, cuts total costs.

Attendees have access to Donna for technical assistance and will provide study investigators information at 12 and 24 months on any changes made in benefits or benefit design. Thanks again Donna for bringing this valuable information to our members!!

Addressing Over-Use by Reducing Diagnostic Imaging Services

2010-01-29T09:53:00.001-06:00

The quality crisis is generally described as consisting of:

Under-use
Mis-use, and
Over-use.

Addressing under-use has generally been greeted with universal support, as increasing use of high value services makes sense to employers and purchasers and generally increases revenues for providers and health care organizations because more services are provided.

Addressing mis-use has generally been philosophically supported because, after all, how can someone morally support harming people in the system? Although philosophical support has been there, what to do to reduce or eliminate mis-use has been very controversial and progress has been slow.

But, work on over-use has been almost non-existent. Reducing over-use will directly impact health care organization's revenue. But now that cost has reared its head again as a major issue for purchasers, reducing over-use of services that provide little to no clinical value is back on the front burner.

In November 2008, the National Priorities Partnership, a group of 32 organizations convened by the National Quality Forum, announced 6 priorities, including reducing "overuse" of services that provide little to no clinical value (click here to learn more about all 6 priorities). The Partnership actually listed potential areas of over-use that should be addressed.

The over-use that seems to be front and center is diagnostic imaging. Significant work is being conducted
in both Washington state and Minnesota. Click here to read Bruce Seigel's (National Director of the Aligning Forces for Quality project) blog post on how organizations in these states are addressing overuse of imaging services by publicly reporting physician use of imaging services and establishing community-wide standars for appropriate use of imaging.

Two-Track Approach to Making Health Reform Happen

2010-01-29T09:05:00.000-06:00

Pelosi has indicated that a two-pronged approach will be taken to health reform:

Pass those reform items where there is general agreement between the Senate and House versions now.
Delay more comprehensive health reform.

Reforms likely to be passed soon address financial access to insurance, underwriting issues, and Medicare value-based purchasing.

Delayed issues are likely to include new taxes, insurance exchanges, and expansion of Medicaid.

Click here to read the article, which includes detailed lists of what is likely to be in any health reform package that is passed in the short-term and those reforms that will, most likely, have to wait.

A Thoughtful Commentary on Health Reform

2010-01-28T20:04:00.000-06:00

I can't do this piece justice to summarize, so please just read. You (and/or I) may not agree with all he says, but he does lay the issues out in a thoughtful manner. Well worth the read..

Click here to read more.

Health Care Reform & GINA Update Week of January 25, 2010

2010-01-27T15:00:00.002-06:00

NBCH reports on the latest strategies being considered by the Democrats regarding health reform. The update describes the strategy and comments on how likely the strategy is to succeed.

The update also includes the latest on GINA.

Click here to go to MBGH's temporary website to download the full health reform update.

Cleveland Clinic Expands Wellness Benefits to Dependents

2010-01-26T14:08:00.000-06:00

Cleveland Clinic now offers their wellness programs free of charge not only to employees, but to dependents as well. Free benefits include weight loss programs, smoking cessation treatment and medications, and fitness center memberships.

This is just one more step in a progressive wellness initiative that began in 2005. That year, Cleveland Clinic instituted smoke free campuses and in 2007 stopped hiring smokers. Since then, they have banned trans fats from their cafeterias and paitent meals.

By making wellness a "family benefit" Cleveland Clinic hopes to be an employer of choice.

Click here to read more.

Health Care Reform Update: Implications of the MA Election

2010-01-26T04:59:00.001-06:00

The following update is made possible through MBGH's membership in the National Business Coalition on Health. It was provided on January 20,2010.

Congressional leaders and the Obama Administration reportedly remain close to a very delicate and tedious agreement on several aspects of a final health care reform bill, though the process may be seriously influenced by result of the special senatorial election in Massachusetts (MA) yesterday to fill the seat of Senator Edward Kennedy (D-MA). The Republican senatorial candidate, Scott Brown (R) won yesterday with 52 percent of the votes against Massachusetts State Attorney General Martha Coakley, who garnered 46 percent of the votes.

IMPACT ON HEALTH CARE REFORM (HCR): Once Senator-elect Scott Brown is sworn in (the date has yet to be announced), the Democrats will lose their filibuster-proof "supermajority" in the Senate, and the House of Representatives could be compelled to pass the earlier Senate-passed bill outright or quickly negotiate a compromise bill before the new Senator can be sworn in.

At that stage, the budget reconciliation process (requiring only a simple, 51-vote majority in the Senate) could be used to advance a possible second health bill that would follow closely on the heels of the first measure to carry out the key provisions currently being negotiated among congressional leaders and the Obama Administration.

As a contingency plan, the Senate and the Obama administration also still seem to be “courting” centrist Senate Republicans such as Olympia Snowe (R-ME) to solidify the 60 votes needed to pass HCR. The White House and Senate leadership also is working to ensure their own caucus is behind the bill (i.e. Senators Nelson (OK) and Landrieu (LA). In addition, the House is struggling to maintain the 218 votes needed to pass their newest version of HCR when the time comes. Caucus defections are plentiful though the latest House version seems to be more moderate (no public plan and no Cadillac plan excise tax) which could capture more conservative Democrat votes (this is the group that defected during the original House vote in July due to cost and abortion language concerns).

In terms of advocacy, everyone still is moving forward in the belief that the final product can still be improved before its final consideration by the House of Representatives and Senate.

Some of the major priority employer concerns with HCR legislation include

• the need for the legislation to reduce health care costs and improve quality,

• avoidance of onerous mandates that would limit the flexibility and innovation that are the foundation of the employer-based system,

• maintenance of the ERISA regulatory structure and

• the need for supportive tax policy that will not undermine employer-sponsored health coverage or add to its cost.

Value-Based Insurance Design Can Be Cost Effective

2010-01-25T16:14:00.001-06:00

A study released in the January 21, 2010 edition of Health Affiars conducted by Michael Chernew at Harvard Medical School showed that a value-based insurance design that reduced copays to encourage employees to use high value medical services lead to reduced use of "non-drug services" which more than offset the increase in prescription drug use encouraged by the lower copay.

Click here to read the abstract and to access the full article.

Senate Health Reform Bill Could Cost Businesses Additional 7-10%

2010-01-25T12:01:00.000-06:00

The HR Policy Association, a group of the country's 300 largest firms, estimates that if the Senate version of health reform were to pass, large businesses could see their health care benefit costs increase an additional 7-10% over the next decade. This cost increase is in addition to current trend increases.

The analysis, performed by Applied Economic Strategies, includes costs associated with new taxes and cost-shifting to private sector payors that is likelys to occur with decreases in Medicare and Medicaid funding.

Click here to read more.

Whole Foods Kicks Off "Health Starts Here" Initiative

2010-01-24T08:20:00.001-06:00

Look for the new "Health Starts Here" program for Whole Foods team members and customers. In-store programs, recipes & educational material, and identifying healthy, nutrient-dense foods by posting signs with Aggregate Nutrient Density Index (ANDI) scores are all part of the program.

Whole Foods Team Members have two additional programs to support their healthy eating: more significant discounts off Whole Foods purchases if they are nicotine-free and meet cholesterol, blood pressure, and BMI targets; and a total immersion program, which includes medical consultation at no cost to the employee, at certain locations.

Click here to read more.

Study Shows Incentive-based Fitness Programs Reduce Cost

2010-01-23T16:57:00.001-06:00

A study published in the American Journal of Health Promotion on January 21, 2010 shows that members participating in an insurance plan's incentive-based fitness wellness program had lower healthcare costs, fewer hospital admissions, and shorter lengths of stay in the hospital when they were hospitalized. The study does indicate that more research is needed to understand the long-term effectiveness of these incentive-based programs.

Click here to read more.

Chattanooga Hospital Not Hiring Tobacco Users

2010-01-23T10:30:00.000-06:00

Memorial Hospital in Chattanooga has decided not to hire tobacco users. The Hospital indicates this decision was made as part of its commitment to a healthy community and not to save health benefit costs. The new rule does not impact current employees. The hospital will add nicotine testing to its existing program to screen for illegal drugs.

Click here to read more.

Workplace Wellness Programs Do Generate Savings!

2010-01-23T09:57:00.001-06:00

A recent article in Health Affairs reports that Harvard University investigators found workplace wellness programs can generate $3.27 in savings for every $1.00 spent & absenteeism savings of $2.73 for every dollar spent!!

Click here to read more.

Health Care Reform Premium Impact

2010-01-23T09:34:00.001-06:00

Although it looks like health reform is not moving forward in it current form for now (or maybe ever), it is still interesting to know what type of impact reform would have on premium costs. Wellpoint has calculated the impact of health reform on premium rates in 14 states where Wellpoint operates. Taking a look at Georgia, Kentucky & Missouri, the closest states to TN, may give us an idea of what TN could expect in the individual and small group (fully insured) market. Click here to access the detailed information.

Although the percent change is different in each state, there are common results: highest increases for younger/healthy individuals or small groups, substantial increases in average age/health individual market, and significant decreases for older/less healthy.

                             Younger/ Healthy     Average Age/ Average Health      Older/ Less Healthy
Georgia:

Individual                      130%                              72%                               -18% (decrease)

Small Employer               69%                              14%                               -38% (decrease)

Kentucky:

Individual                       178%                            106%                              -17% (decrease)

Small Employer                 99%                              21%                              -39% (decrease)

Missouri

Individual                        178%                           106%                              -17% (decrease)

Small Employer                 89%                             17%                              -26% (decrease)

MBGH Has a New Look

2010-01-12T03:55:00.003-06:00

Look at that. It’s our new logo. MBGH is actively engaged with our members and the community, and we wanted a logo that reflects the spirit of MBGH today - bold, strong, focused.

We also have a new way of describing ourselves.

“MBGH is a coalition of employers sharing solutions and providing tools to manage the cost and quality of health benefits in an ever-changing environment. We do this by providing access to critical market data, facilitating best-practice sharing among the market’s leading employers, and offering practical tools for successfully managing healthcare benefits.”

Our new tagline sums it up, we are about “Connections. Tools. Solutions”

Connections. MBGH programs and initiatives support our “sharing solutions”.
• Topic-focused in-person meetings
• MBGH’s Annual Conference
• Webinars addressing health and benefit issues identified by our members
• Newsletters, blogs and social media for networking and learning
• Publication of a membership directory so members can contact each other directly.

Tools. These are the resources MBGH provides our members to help improve performance of health plans. In 2010, we’ll launch a new website with a resource and tool kit section addressing:
• Benefit design
• Vendor management
• Worksite-based programs
• Employee engagement.

Solutions. In addition to sharing tools and solutions targeting what employers can do to improve health benefit plan performance, MBGH remains committed to health care system reform in Memphis and nationally. Our members’ health plans perform best when the health care system is cost-efficient and provides high-quality care. MBGH will continue our leadership in measuring and reporting cost and quality performance and implementing employer-based programs/approaches to facilitate improvement in:
• Hospitals (Leapfrog)
• Physicians (Aligning Forces for Quality through Healthy Memphis Common Table)
• Health plans (eValue8)

We are developing tools for you and your employees to use this information to improve the performance of your health benefits through employee engagement, health plan contracting, and network selection.

It is exciting to have this new look, especially as we enter a new decade. We look forward to working with you in 2010 and beyond.

"No One Knows What Goes On Behind Closed Doors..."

2010-01-06T09:14:00.000-06:00

House starts health reform reconciliation process in closed door meetings. Pelosi indicates the House will not necessarily just adopt the Senate bill as written, specifically re: the Public Option.

Click here to read more.

Save Dollars & Improve Health By Avoiding Hospital Acquired Infections

2010-01-05T09:16:00.001-06:00

On average, hospital acquired infections add $15,000 to a patient's hospital bill. One in 20 patients admitted to the hosptial get a hospital acquired infection. Your cost and the health of your employees are impacted significantly by these hospital acquired infections!!!

You can reduce your cost and improve the care for your employees and their families by sharing this CDC podcast on your intranet to educate your employees about how to protect themselves and their families from hosptial acquired infections if they are admitted to a hospital. CDC is making this podcast available to hospitals to play for patients upon admission, but being prepared ahead of time is the best policy and the hospitals your employees use may not play this video.

.

Be Prepared for New Health Benefit Mandates in Health Reform

2010-01-05T08:38:00.000-06:00

New Metlife survey shows 30% of employers don't expect their health benefits to change after health reform..but, there are plan design mandates in both House & Sentate versions that have profound implications for employers and that would change benefits.

Click here to read the SHRM article that outlines these mandates as well as other interesting findings from the Metlife survey.

Click here for a review of the implications of health reform for employers from Mintz Levin law firm.

No Formal Conference Committee Reconciliation for Health Reform?

2010-01-05T07:55:00.000-06:00

It looks like the Dems are considering bypassing the formal Conference Committee reconciliation process of forging a single health reform bill to send back to both the House and Senate. Instead, they are considering letting House and Senate Democratic leaders hammer out a bill (in private meetings), probably largely based on the Senate version, to send back to the House.Upon passage in the House, the bill would then go back to the Senate. This approach is being considered to minimize the Republican's ability to delay passage. But, Republicans are concerned this approach "shuts out the American people and breaks one of President Obama's signature campaign promises."

Click here to read the article.

2009 Was a Great Year for MBGH!!

2010-01-01T21:54:00.003-06:00

2009 was great for MBGH..celebrating hospitals, health plans & physicians that are improving quality & efficiency of care in Memphis, holding our first annual conference, hosting the NBCH Board at Graceland & NBCH meetings in Memphis, and representing Memphis employers in Nashville, DC, Pittsburgh, Dallas, Phoenix, Philadpelphia and beyond..We look forward to 2010!!

Hospital Proves That Improved ICU Quality Saves Dollars

2009-12-31T09:38:00.001-06:00

Sentara Williamsburg Regional Medical Center (SWRMC) has gone 5 years and hopes to celebrate its 6th year of no ventilator acquired pneumonia (VAP) cases in its ICU. This experience puts SWRMC in the top 10% of hospitals nationally in VAP experience. SWRC's ICU costs are $6,000 less that other comparable hospitals.

VAP is the second most common hospital acquired infection and the most common in ICUs.

This achievement is due to managing length of stay and ventilator days through:

Screening protocols which result in fewer patients being put on ventilators in the first place
Implementing the Institute for Health Improvement's ventilator bundle
And, as The Leapfrog Group requires, using a dedicated intensivist (a physician specially trained in critical care medicine) in the ICU.

SWRMC's experience shows that better quality does indeed cost less. Employers have a vested interest in whether or not hosptials implement these types of process improvements as these improvements result in better care for the patient and cost the patient and employer less. MBGH is the Regional Roll Out leader for The Leapfrog Group here in Memphis. Employers should continue to push, through MBGH, for these types of improvements so we too can benefit here in Memphis.

Click here to read the article.

DOL Fact Sheet on New COBRA Premium Subsidy Program

2009-12-30T19:19:00.000-06:00

The Department of Labor just released a fact sheet on how the 2010 Defense Appropriations Bill affects COBRA Premium Subsidies.

Click here to see the Fact Sheet.

COBRA Coverage & Subsidies Extended

2009-12-24T14:22:00.000-06:00

From USA Today: "President Obama has signed legislation that will allow laid-off workers to receive subsidized COBRA premiums for up to 15 months. Previously, the subsidy expired after nine months.
The extension, included in a defense spending bill approved by Congress over the weekend, also extended the cutoff for eligibility for the COBRA subsidy to Feb. 28, 2010, from Dec. 31."

Click here to read the entire article.

Medical Center Chief Medical Officer Proud to Be a Leapfrog Top Hospital

2009-12-24T11:06:00.001-06:00

Dr. Jonathan Gottlieb, Chief Medical Officer at University of Maryland Medical Center, talks about why UMMC is proud to be one of The Leapfrog Group's Top Hospitals for the fourth straight year. It is wonderful to have a major medical center accept the challenge Leapfrog has issued to "trigger giant leaps" in the safety, quality and affordability of health care.

Memphis area hospitals have been national leaders in reporting to The Leapfrog Group's annual Hospital Survey and we have seen progress in the adoption of computerized provider order entry and in staffing intensive care units with physicians trained in critical care medicine. But we still have a long way to go to have a hospital included in Leapfrog's Top Hospital list.

MBGH is challenging Memphis-area hosptials to have at least one hospital on this list in 2011. Let's see which hospital(s) step up and accept the challenge!!

Click here to view the video.

Long List of Concessions Needed To Ensure Passage of Health Reform

2009-12-22T13:44:00.000-06:00

Many concessions were made in the final hours to get the 60 votes needed to pass Reid's health reform package in the U.S. Senate. Concessions ranged from:

Federal funding of extra costs due to Medicaid expansion in certain states
Exempting certain health plans in specific states from new fees
Funding the construction of a new hospital
Exempting certain industries from the new "cadillac plan" taxes
Special Medicare Advantage benefits in specific states

Click here to read more details.

Memphis Medical Society Quarterly Magazine Reports on MBGH's eValue8 Project

2009-12-17T16:16:00.001-06:00

Read the Winter 2010 edition of the Memphis Medical Society Quarterly magazine's highlights of the results of MBGH's 2009 eValue8 health plan evaluation, starting on page 8 of the pdf. Click here for an on-line copy of the magazine.

We're Likely to Continue to See a Decline in Small Physician Practices

2009-12-11T12:24:00.000-06:00

Atul Gawande's latest article in the New Yorker magazine compares the current health care quality and efficiency crisis to a similar crisis experienced in agriculture in the early 1990s. Gawande points out that improvements in agriculture, driven by scientific and technological advances and evidence-based efficiencies, resulted in farm consolidation and the rise of big "agribusiness". And, the small farmer suffered as they became less competitive with larger, consolidated farms.

Gawande postulates that small physician practices may face a similar situation. Pressures for physicians to consolidate will only increase with the emphasis on performance measurement and outcomes-based payment methologies.Given this direction, we are likely to see the number of small practices continue to decrease.

Click here to read a summary of the article's points on small physician practices.

Click here to read Atul Gawande's complete article.

Senate Democrats Making Progress on Health Reform Legislation

2009-12-09T07:21:00.000-06:00

Key new elements of the reform legislation Senate Democrats are sending to the Congressional Budget Office for scoring include:

Opening Medicare beginning at age 55
Non-profit national plans administered by the Federal Office of Personnel Management
Requirements that insurance companies spend 90% of the premium on medical benefits (vs. administrative costs)

These new elements were negotiated by a group of 10 Democrats -- 5 liberal & 5 moderate -- in closed door negotiations. The plan is now being sent to the Congressional Budget Office for scoring and more details will be available once CBO releases their findings.

Technically, the "public option" is off the table, although the term may still be used to describe the expansion of Medicare or the national non-profit plans. However, the public option as originally envisioned appears to be gone.

Click here to learn more.

Mercer Survey Shows Employers Would Cut Benefits to Avoid Excise Tax

2009-12-08T08:07:00.000-06:00

Mercer surveyed 465 employer health plan sponsors to find out how they would respond to the excise tax portions of the proposed health reform legislation. Major findings included:

63% indicated they would cut benefits to avoid paying the excise tax. 23% indicated they would pass the tax on to their employees.

75% of those that would cut benefits would do so by increasing employee deductibles and copayments.

52% of all respondents (small, medium & large employers) favor an individual mandate. 65% of large employers (5,000+ employees) favor an individual mandate.

Click here to get more detailed survey results.

Memphis Firms Await Health Reform Scenarios

2009-12-05T10:05:00.000-06:00

MBGH's board member, Jane Pienaar of Morgan Keegan, is highlighted in this article covering MBGH's November 24 health reform meeting with Andy Webber, CEO of the National Business Coalition on Health. The title says it all: "Firms await health reform scenarios" before they make strategic changes...

Click here to read the Commercial Appeal article.

No Memphis Hospitals on Leapfrog's Top Hospital List

2009-12-04T10:40:00.001-06:00

No Memphis hospitals are on The Leapfrog Group's Top Hospital list for 2009. Only TN hospitals were Vanderbilt University Hospital and The Monroe Carell Jr. Children's Hospital at Vanderbilt. I'm challenging Memphis hospitals to have at least one of our hospitals on this list by 2011. Which hospital(s) want to help make this happen?

Click here to see the entire list of Top Hospitals.

Confused Over the New USPSTF Recommendations on Screening Mammorgraphy?

2009-12-04T07:44:00.000-06:00

There has been a lot of media coverage and confusion over the change in the U.S. Preventive Services Task Force recommendations on screening mammography. To get the complete and accurate story, click here to read the full recommendations and rationale for the change.

A summary of the recommendations is presented below, including a quote from Diana Petitti, MD, MPH, Vice Chair of the USPSTF before U.S. Congress on November 19, 2009.

The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. The decision to start regular, biennial screening mammography before the age of 50 years should be an individual one and take patient context into account, including the patient's values regarding specific benefits and harms (emphasis added).
Grade: C recommendation. (The USPSTF recommends against routinely providing the service)

"So, what does this mean if you are a woman in your 40s? You should talk to your doctor and make an informed decision about whether a mammography is right for you based on your family history, general health, and personal values."
Diana Petitti, MD, MPH
Vice Chair, U.S. Preventive Services Task Force
November 19, 2009

* The USPSTF recommends biennial screening mammography for women aged 50 to 74 years.
Grade: B recommendation. (The USPSTF recommends the service)

* The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of screening mammography in women 75 years or older.
Grade: I Statement. (Insufficient evidence)

* The USPSTF recommends against teaching breast self-examination (BSE).
Grade: D recommendation. (The USPSTF recommends against the service)

* The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of clinical breast examination (CBE) beyond screening mammography in women 40 years or older.
Grade: I Statement. (Insufficient evidence)

* The USPSTF concludes that the current evidence is insufficient to assess the additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) instead of film mammography as screening modalities for breast cancer.
Grade: I Statement. (Insufficient evidence)

MBGH Had a Full House at our Health Reform Update

2009-11-24T14:01:00.000-06:00

Andy Webber, CEO and President of the National Business Coalition on Health, updated a capacity crowd at this morning's MBGH "Health Reform: How It Affects Employers" breakfast meeting at the Crescent Club.

Andy focused on the major provisions that impact employers:

The employer mandate and "pay or play" proposals, including the federally mandated minimum benefit design
The development of insurance exchanges and the public option
Excise tax on "cadillac" plans and
Workplace health promotion incentives.

Andy believes that there will be some type of health reform passed and signed into law by the first quarter 2010, perhaps as early as the President's State of the Union Address in January. According to Andy, there is just no other option for the Democrats but to pass SOMETHING. The exact shape of that "something" is still to be determined, especially the fate of the public option.

Click here for a copy of Andy's slides.

We Need a Holston Medical Group in Memphis!

2009-11-20T08:08:00.000-06:00

We need a "Holston Medical Group" in Memphis!!! Blown away at the "Preparing for a New Healthcare Landscape" meeting by the clinical, administrative, & cost outcomes Holston Medical Group has achieved with their emphasis on electronic medical record, team approach to care, and general "accountable care organization" philosophy. Who is willing to do this in Memphis? Can't wait to get Dr. Jerry Miller to Memphis to share his knowledge & inspire change...

Hot Off the Press at the NBCH Annual Conference

2009-11-10T17:20:00.000-06:00

The Annual Conference of the National Business Coalition on Health has just concluded and it was the best conference yet for NBCH. Timing could not have been better with the House passing health reform on the Saturday night before the conference began on Sunday morning. But this conference did not focus on national health reform (although clearly there was plenty of buzz and even a session or two on it), but on the fact that real health reform is happening in local communities, such as Memphis, and that it will take a long time for national reform to really change what happens at the local level. Here are some of the key take aways from the Conference:

Employer Payment Options:

The national health reform we appear to be getting is not payment reform, so employers will have to do that ourselves.

There is no one-size fits all in payment reform methodology because each market's health care delivery system infrastructure is different and applying one method across the country could result in dire consequences. In Memphis, for example, reference pricing may be something for us to consider since we have a consolidated hospital market, where in other markets other market-driven approaches may work better

Reference pricing (tying what an employer pays to the most efficient provider's price within a market) was the most discussed payment methodology that could be implemented today. Safeway and other major employers are already doing it with their health plans. Key issue is defining the "market" which most suggested would be much larger than the traditional market definitions for tertiary services such as heart surgery, knee surgery, etc (not primary care or chronic care management). In Memphis, maybe we include Nashville in our market? This approach means that we would be expanding the market for where we “incent” our employees to go for care, but it may be an approach worth considering if pricing becomes too high locally and quality is either equal to or below what our employees could get elsewhere.

Accountable Care Organizations (ACOs) operated by hospitals that end up "consolidating" hospitals and medical staffs would limit referral patterns and probably increase prices, and therefore costs, because of increased bargaining power. In Memphis, this could be possible if either Methodist or Baptist consolidated with their medical staffs. We would want to be sure that employers reaped the clinical/outcome benefits of this consolidation at a reasonable cost. We would want to consider packaging this approach with reference pricing to be sure prices did not get out of control..

Employer Benefit Design:

We should move toward value-based benefit design (which we have started in Memphis) and then to value-based payment.

You can say no then say yes, but you cannot say yes and then say no. In other words, it is easier to say yes to something you have denied in the past vs. taking away something you have given in the past. Applying this to benefit design, be strict on the front-end and say yes to those services/benefits that are evidence based (and provide them at no cost to the employee) and no to everything else (or assign a very high copay). Then, as the evidence becomes clear that something is effective, enhance coverage.

Public Reporting:

We need to move toward measuring and reporting whether "appropriate care" was provided. Move from measuring gross volume and outcomes to whether the right people got the right care...a very different paradigm. This will address employers’ concerns about “over-use” and “waste” in the system and help ensure that employers only pay for the right care.

Health Reform:

If the public plan is structured where it is on a level playing field with commercial plans, why do we need it?

The AHA seemed to imply that hospitals are "too big to fail" because of their tax free bonds that have not yet been paid....Probably a message being delivered to Congress quite regularly.

I am sure there is much more to share, but these are the highlights. Great meeting and great speakers...Great thinking for us in Memphis on how to deploy some of these strategies to improve the cost and quality of health benefits!!!

How Do We Save the Med?

2009-11-04T13:44:00.000-06:00

The discussion on how to save the Regional Medical Center at Memphis (the Med) is heating up. The Med's Board has indicated that it will close the emergency room, 70 medical/surgical beds, and outpatient clinics if $32 million is not found by February 2010.

An idea floated by Shelby County Commissioner Mike Ritz is to add a 2% tax on all hospital services in Shelby County (click here). A letter to the editor from Gary Shorb, CEO of Methodist Healthcare calls for "public support" of the Med (click here), but is unclear as to what form that support should take. Gary Gunderson and Scott Morris, in a special Viewpoint column today (click here), call upon us to "pray with all of your might for the health of our city, for those who will be affected if The Med emergency room is closed. We also call on all to pray for the strength to make wise decisions that will lead Memphis to be a city where rich and poor alike have the benefit of being cared for when we are most vulnerable."

This last call by Gunderson & Morris is a call to action to make "wise decisions". But what is the wisest decision? To burden those who are paying the high cost of health care by adding an additional 2% tax to their already high bill could have dire unintended consequences. One of those consequences could be pricing health care services out of reach of even more people, adding to the community burden of the uninsured. The call for public support could possibly take the form of a broad-based strategy to raise revenue for the Med. After all, if it is indeed a community resource or "utility" then don't we all have a role to play in keeping it viable?

One last thought: as I wrote to the CA back in August 2008 (click here), the Med owes us something in return for our financial support. It owes us a well-run, efficient hospital offering our community the highest quality care for the services it provides. As Gary Shorb points out, the Med has made progress in these areas. However, the Med should make a commitment to be held publicly accountable for the cost and quality of their care by agreeing to publicly report their progress in implementing critical patient safety and quality improvements by reporting, like the other Memphis-area hospitals, to The Leapfrog Group Annual Hospital Survey (click here).

We are being asked to dig deep into our pockets as citizens to support the Med, and the Med should prioritize showing us that it is worthy of this support.

Purchasing High Performance Newsletter Now Available

2009-11-04T09:31:00.000-06:00

Memphis Business Group on Health announces the release of the latest edition of "Purchasing High Performance", a newsletter designed to help employers manage the quality & cost of their health benefit plans. Great articles on health reform, employer best practices, employee incentives, health delivery system reforms and more.

Click here to access the newsletter.